Health System Reform and Ethics:
Private Practitioners in Poor Urban Neighbourhoods in India, Indonesia and Thailand

Project Site

Thailand - Phitsanulok

Phitsanulok municipality has approx. 100,000 inhabitants and is located in the northern part of Thailand, 377 Kilometres from Bangkok. It is a center for migration from rural areas of the lower northern part of Thailand. It is estimated that around 10% of the population in Phitsanulok live below the poverty line. Two neighbourhoods were included in the study; one, with approx. 1,000 inhabitants (105 families), was located east of the Nan river and the other was a resettlement area with approx. 1,000 people. Most of the inhabitants had migrated from other places. Many earned their living being hired on a day-to-day basis as construction workers, housekeepers, tricycle drivers, and working with laundry and ironing.

Both areas have electricity and water supply. One neighbourhood has a high migration rate and many live in temporary, rented dwellings. People in the other neighbourhood stay permanently and own their houses but not the land. However, many go to other parts of Thailand temporarily (3-8 months) for construction work or other jobs. Both areas have a primary care unit (PCU) that provides health services under the universal insurance scheme (30 Baht scheme). Migrants who are not registered as local citizens do not have access to public health services under the 30 Baht scheme and may therefore need to go to private practitioners when they face health problems. Private practitioners and drug stores are easily accessible for people in both neighbourhoods.